Last Updated: Sep 24, 2019
Heather Farley, MD, MHCDS, FACEP, was a successful physician running the emergency department for Christiana Care Health System in Middletown, Del. She was being groomed for additional leadership positions within the organization when her whole world changed.
One winter day, Dr. Farley had cared for a patient and, following the standard of care, discharged the patient from the emergency department. The patient died on the way home from the hospital.
“That case really rocked my world professionally and personally,” Dr. Farley says. “That experience as a physician — thinking, ‘Did I make a mistake? Did I miss something? Is it my fault this person is no longer there for their family?’ That’s pretty difficult to navigate as a physician and one of the unique and particularly challenging circumstances we have to deal with.”
Dr. Farley went to a dark place. Without a support system established, she kept her feelings to herself.
“There is a culture of silence and shame in medicine, and you don’t talk about things like this. So, I didn’t,” she says.
Inside, she didn’t want to be a physician anymore.
“I was going to find anything else besides medicine to do and actually got to the point of writing my letter of resignation and gave it to my boss,” she says. “To his credit, he didn’t accept it.”
Instead, Dr. Farley’s supervisor worked with her with the help of an executive coach.
“I was able to rediscover why I went into medicine in the first place,” she says. “I recognized that I still had value as a physician, and there were still things I enjoyed about medicine.”
Caring for the Caregiver
Dr. Farley’s story is one that many physicians can relate to, but few discuss.
“I did some research, and there is a whole body of literature around this — being the [second] victim and all the emotional trauma that health care providers go through after experiencing adverse events,” she says. “It was actually the fork in the road for me in my career. I realized that I didn’t want anyone to ever go through what I went through.”
Physician Wellness Town Halls
PAMED is hosting 3 Physician Wellness Town Halls this fall. Dr. Farley is speaking at the Scranton and Erie events.
With this insight, Dr. Farley embarked on a culture change in her own organization and developed the Care for the Caregiver peer support program. She trained 45 peer supporters who now provide emotional first aid to medical professionals across Christiana Care Health System.
“They serve as a friendly, confidential ear from someone who has been there to help you process those difficult emotions that are part of an adverse event,” Dr. Farley says.
Creating this program spurred her interest in overall physician well-being. There was no blueprint for doing this type of work, even though it was desperately needed.
Dr. Farley proposed a comprehensive program around physician and health care provider well-being. And with support from the very top leaders at Christiana Care, the Center for Provider Wellbeing opened in 2016.
“The Center for Provider Wellbeing aims to foster joy and meaning in work for providers and their teams,” Dr. Farley says. “I think we are a model for the rest of the nation and internationally on how to do this well.”
With the leadership of Dr. Farley and her team, Christiana Care has expanded its focus beyond individual support to interventions that increase the resilience and well-being of teams, as well as programming that reaches across departments and service lines.
The Center has representation on the National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience, and Dr. Farley sits on the steering committee for the national Physician Wellness Academic Consortium led by Stanford University.
Prioritizing a Culture of Wellness
Many consequences arise when physicians burn out. Dr. Farley puts them into three categories: patient care, financial, and personal.
“There are links between burnout and increased medical errors, decreased patient experience scores, and adherence to medical treatment recommendations,” she says. “Being well ourselves really impacts the quality of care we are able to provide our patients.”
Dr. Farley also believes investing in care provider well-being is a smart choice for health systems, given the financial cost of burnout.
“Burned out physicians are less productive but also more likely to leave an organization,” she says. “The cost of physician turnover is anywhere from $250,000 to $1.1 million per physician.”
But the consequences Dr. Farley focuses on most are personal.
“Burned out physicians have higher rates of depression, divorce, and death by suicide,” she says. “The suicide rates for physicians are astronomical with more than 400 physicians per year dying by suicide.”
Female physicians, in particular, have a higher rate of burnout and suicide.
“Women often have the dual role burden of being a caregiver at work and a caregiver at home, and in general they feel more pressure and tend to take on more of that care in the home and care of the children than their significant others,” she says.
Ultimately, Dr. Farley hopes her work makes a positive impact far and wide.
“A lot of my work has been focused on changing the environment in which our physicians work,” she says. “I like to use the canary in the coal mine analogy — you can’t just take the canary and teach it to be more resilient and stick it back in the same coal mine and expect it to survive. You actually have to change the coal mine.”
A version of this article appeared in the spring 2019 issue of Pennsylvania Physician Magazine, PAMED’s print magazine, and was reprinted with permission.